Reshaping a wide and prominent forehead is done by bone reduction, removing as much outer cortical bone of the skull as is needed to create more of tapered forehead shape. Most of the bone removal is done on the sides crossing the anterior temporal line as needed. This usually requires release of the superior attachments of the temporalis muscle and fascia.
Many wide foreheads also have a central flat area either in the glabellar or just above the glabellar region. This is normal and even expected as the wider the forehead the more likely it will have a flat profile. While not all wide foreheads have this central flatness it is important to look for it
As a complement to forehead reshaping to achieve a more narrowed look, augmentation of the flatter central or glabellar area can be helpful. This is most easily done by adding a small amount of PMMA bone cement to the area and contouring it smooth and flush with the surrounding frontal bone. Because it is a small implant it is best to secure it with small titanium screws that are placed flush to the implant.
Adding a small amount of central projection to the central forehead can help make the look more narrowed and contoured when done with aggressive side bone reduction. This is an easy addition to an open forehead recontouring procedure.
Dr. Barry Eppley
Indianapolis, Indiana